CEREBRAL EDEMA AND REACTIVE PSYCHOSIS AFTER THE CORONARY ANGIOGRAPHY AND STENTING: CLINICAL CASEJournal: Art of Medicine (Vol.3, No. 2)
Publication Date: 2019-05-28
Authors : M.I. Ulianovska;
Page : 148-151
Keywords : complications of the coronary angiography; brain edema; reactive psychosis;
Coronary angiography is an invasive diagnostic method performed by introducing a contrast agent into the coronary arteries (СА) under X-ray control. Coronary stenting is the implantation of a metal stent in the affected segment of the CA to restore blood flow. These procedures are getting more and more frequent applications both in Ukraine and abroad. Taking into account the foregoing, the study of the complications that may arise in the process or after coronary angiography and stenting seems particularly relevant. The literature data indicate that neurological disorders are rare complications of these procedures, often referred to as a stroke. The article presents the clinical case of a patient of 45 years old who entered the cardiology department with symptoms of angina pectoris which appeared for the first time two weeks before, for a planned coronary angi-ography. The examination revealed a critical stenosis of the left coronary artery and a stenting of the affected segment was implemented. In 20 minutes after the coro-nary angiography and stenting of the LCA, the patient noted discomfort behind the sternum. Objectively: the patient is mentally inhibited, the speech is indecisive, he oriented correctly in time, space and his own person. Hemodynamics: blood pressure - 150/90 mm Hg., pulse - 74 beats / minute, rhythmic. ECG - sinus rhythm, correct, heart rate - 74 / min, T (-) in III, aVF. 2 hours later. - a state of a patient with a negative dynamics, the inhibition is replaced by aggression. Hemodynamics: 160/110 mm Hg. Ps. - 90 av./min., rhythmic. Neurological status: pro-nounced psychomotor excitation, patient does not follow the instructions, does not speak, pupils D = S, symmetrical face, movements in the limbs are preserved, meningeal symptoms are absent, physiological reflexes D = S, abnormal reflex of Babinsky on both sides. As the most frequently described neurological complication of the angiography is a cerebral stroke, this patient was suspect-ed of acute cerebrovascular accident and a CT scan of the brain was performed to verify the diagnosis. As a result, the diagnosis of stroke was not confirmed, but the large arachnoid cyst was found, as well as signs of cerebral edema. It can be assumed that the cyst has been formed as a result of meningitis. It is also suspected that the sharp deterioration in the patient's condition happened due to the brain edema. The patient was transferred to the intensive care unit. After 1.5 days the symptoms regressed, retrograde amnesia was present. Three days after admission to the hospital, the patient was discharged in satisfactory condition under the supervision of a family doctor, a cardiologist, a neuropathologist.Control neuroimaging was conducted. MRI: No diffuse and focal changes in the brain were detected. Convexital arachnoid cyst in the right frontal lobe 64 * 26 * 36 mm, with moderate compression of the adjacent parts was found. EEG was conducted, epileptiform EEG was diagnosed. This patient has a rather unique complication, the cause of which could be the toxic effect of angiocontrast due to a compromised neurological history.
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